Psychiatrists say ED's have become the "default" facility due to lack of community services.
Mental health patients are absconding daily from emergency departments because of a lack of community services.
Dr Vanessa Thornton and Dr Kate Allan highlight the challenges of managing patients suffering mental distress in overcrowded EDs.
Mental Health Foundation CEO Shaun Robinson and psychiatrist Dr Hiran Thabrew call for community-based alternatives and a comprehensive mental health strategy.
Mental health patients are absconding “every day” from hospital emergency departments (EDs), which have now become the “default” facility for people in distress amid a lack of community services, according to ED doctors and psychiatrists.
Official information obtained by the Herald gives an insight into the issue at MiddlemoreHospital’s ED, where in just 36 days last winter, a patient safety report said five mental health patients absconded from the ED, one of whom tried to self-harm as soon as they got outside the front door.
Emergency physician and Counties Manukau group director of operations Dr Vanessa Thornton told the Herald processes are in place to keep those who are actively suicidal at the ED.
“We normally call the police to pick those patients up and we do have people who abscond every day, not just on busy days. Any day, a person who’s determined to get out can get out,” she told the Herald.
Dr Kate Allan, New Zealand chair for the Australasian College of Emergency Medicine. Photo / Jason Dorday
The New Zealand chairwoman of the Australasian College for Emergency Medicine and ED physician Dr Kate Allan said there were “many examples” of mental health patients absconding from EDs as overrun staff were often unable to continually watch patients.
“Care gets diverted and prioritised to those acute patients who are coming in who are significantly unwell, and we have to manage that, to ensure that we prevent people dying,” she said.
“This is an example of what’s happening in our [ED] departments every day. It’s an example of patients who are spending typically very long times in emergency departments waiting for an inpatient bed.”
A review written by clinicians and obtained by the Herald has raised serious concerns about staff and patient safety at Middlemore Hospital's emergency department. Photo / Jason Dorday
Rates of adolescent mental health ED presentations increased by 289% between 2007 and 2022. By comparison, rates of all adolescent ED presentations increased by 9.8%.
NZ’s ‘national emergency’
Child and adolescent psychiatrist Dr Hiran Thabrew told the Herald EDs are now a “revolving door” for mental health services despite EDs “never being built or resourced” to provide such support.
“We know that EDs are the default point now for accessing mental health care because people seem to not have anywhere else to go,” he said.
Dr Hiran Thabrew is a child and adolescent psychiatrist and chair of the NZ office of the Royal Australia and NZ College of Psychiatry. Photo / RNZ / Cole Eastham-Farrelly
Thabrew said this was a worrying trend and a symptom of the lack of community services and expert staff to work within them.
“Those at greatest risk are not having their needs met in the community and are having to present to ED,” he said.
New Zealand ranked the lowest among 36 other OECD countries for mental wellbeing, according to recently released Unicef research.
Thabrew, who’s also chair of the New Zealand office of the Royal Australian and NZ College of Psychiatrists, likened the situation to a “national emergency”, highlighting the country’s lack of psychiatrists and record youth suicide rates.
Investment seems to have been patchy, poorly planned, and reactive.
Responding to the Government’s Budget last week, he said he believed there was no national plan to deal with the country’s mental health crisis and called investment to date “patchy” and “reactive”.
That was something he said was disappointing.
The Budget included $28m to establish mental health teams to respond to 111 calls from people experiencing mental distress.
The funding followed the decision by police to opt out of providing some services.
Thabrew supported this and funding of “peer support” workers at EDs – who comfort those in mental distress – but said major reform was needed.
“We’ve seen no comprehensive strategy, no dedicated roadmap, and there’s no urgency to meet the scale of need,” he told the Herald.
He said despite rising distress and workforce shortages, the Budget failed to deliver ringfenced funding for frontline mental health services.
‘No clear strategy’ on mental health
Shaun Robinson is CEO of the Mental Health Foundation. Photo / Supplied
The CEO of the Mental Health Foundation Shaun Robinson was not surprised patients were absconding from EDs and agreed with Thabrew that EDs had become the “de facto health service for many people” experiencing mental health challenges.
He said EDs are not the appropriate place for such patients, especially if they end up in a corridor amid overcrowding issues.
“What we need are a range of alternatives in the community. A lot of those people, if they could go to a centre in the community where they could get appropriate support and the de-escalation of that situation, they would probably never need to go into hospital,” he said.
He said there was “no clear strategy” to deal with the mental health crisis in the Budget – a crisis which had snowballed over decades because of underfunding.
He supported Mental Health Minister Matt Doocey’s efforts to find solutions.
“I think that the scale of what they’re doing [the Government] compared to the scale of the need is woefully inadequate, but I don’t think that that’s the Minister of Mental Health’s fault. I think he is doing the best he can to get the resources that people need,” he said.
Minister: EDs should be ‘final resort’
Mental Health Minister Matt Doocey. Photo / Mike Scott
Doocey sympathised with the plight of those in mental distress having to contend with overrun EDs, telling the Herald it should be the “final resort” for people seeking support.
“Being in a busy, loud environment with bright lights is not a therapeutic environment for those who are in mental distress,” he told the Herald.
He said peer support workers, who are now in five EDs, including Middlemore, will help those in distress navigate what can be “a very challenging place”.
Doocey also referred to last year’s announcement to set up six so-called “crisis recovery cafes” – community-based centres he believed would prevent people ending up in EDs.
A national mental health and wellbeing strategy would be released in October and Doocey indicated a suicide prevention plan would be out imminently.
Doocey said claims there had been no ringfenced funding for frontline services were not correct, referring the Herald to last year’s Budget announcement of $2.6b being set aside for mental health.
However, psychiatrists say it’s not clear precisely how much of that money is reaching specialist services and hospitals nor how much is being used to address workforce gaps.
Michael Morrah is a senior investigative reporter/team leader at the Herald. He won News Journalist of the Year at the 2025 Voyager Media Awards and has twice been named reporter of the year at the NZ Television Awards. He has been a broadcast journalist for 20 years and joined the Herald‘s video team in July 2024.
